A RESISTÊNCIA ANTIMICROBIANA E CUSTOS DE CUIDADO DE SAÚDE: UMA REVISÃO SISTEMÁTICA

There is a growing concern about the multi-resistant capabilities presented by microorganisms to antimicrobials. Society is harmed by the redirection of financial resources from other areas, also lacking the population, to purchase more potent antimicrobials and in larger quantities. This study describes the consumption of antimicrobial drugs and their impact generated through a systematic review, following the recommendations of the Prisma method. Searches were performed in four databases (Portal BVS, PubMed, Embase and Science Direct). A total of 196 articles were found, 11 of which were selected after applying the eligibility criteria. A prospective study showed that the difference in expenditures can reach $31.17 patients/day between prophylactics and those with nosocomial infections. Studies have shown that the increase in costs is related to the increase in the length of stay. Mortality and admission to the ICU also increased. Further studies with high levels of evidence are recommended.

Nosocomial RSV-related in-hospital mortality in children <5 years: a global case series

Background According to the World Health Organization the global burden of nosocomial infections is poorly characterized as surveillance systems for nosocomial infection are lacking. Nosocomial infections occur at higher rates in low- and lower-middle-income countries (LMICs) than in high-income countries (HICs). Current global RSV burden estimates are largely based on community-acquired disease. We aimed to characterize children with nosocomial RSV-related mortality and to understand the potential impact of RSV immunization strategies. Methods RSV GOLD is a global registry of children younger than 5 years who died with laboratory-confirmed RSV infection. We compared clinical and demographic characteristics of children with nosocomial and community-acquired RSV in-hospital mortality. Results We included 231 nosocomial and 931 community-acquired RSV-related in-hospital deaths from 65 countries. Median age at death was similar for both groups (5.4 vs 6 months). As expected, a higher proportion of children with nosocomial infection had comorbidities (87% vs 57%; p<0.001) or was born preterm (46% vs 24%; p<0.001) than children with community-acquired infection. The proportion of nosocomial deaths among all RSV deaths was lower in LMICs than in upper-middle-income countries (UMICs) and HICs (12% vs 18% and 26%, respectively). Conclusions This is the first global case series of children dying with nosocomial RSV infection. Future infant-targeted immunization strategies can prevent the majority of nosocomial RSV-related deaths. Although nosocomial RSV deaths are expected to occur at highest rates in LMICs, the number of reported nosocomial RSV deaths was low in these countries. Hospital-based surveillance is needed to capture the full burden of nosocomial RSV mortality in LMICs.

Bio-Inspired Antibacterial Coating on Urinary Catheter for Encrustation Prevention

Urinary tract infection (UTI) represents one of the most common nosocomial infections, which is mainly related to indwelling catheters or stents. In addition to the formation of biofilms to resistant...

Application of a Novel PM Model to Assess the Risk of Clostridioides difficile Infections in Medical Facilities as a Tool for Improving the Quality of Health Services and the Safety of Patients

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient’s health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital’s technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient’s stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment.

Evaluation of Emerging Antimicrobials Resistance in Nosocomial Infections Caused by E. Coli: The Comparison Results of Observed Cases and Compartmental Model

Background: The World Health Organization repeatedly emphasizes the spread and association of nosocomial infections with microbial resistance. In a 2014 report, the World Health Organization cited microbial resistance as a global threat. In recent years, the world has seen the rapid growth of antibiotic-resistant E. coli in most areas, which poses a serious threat to public health. A high percentage of bacteria that cause nosocomial infections have been resistant to treatment. The most common bacterial agent among these nosocomial infections is E. coli. This bacterium is one of the main causes of nosocomial infections among hospitalized patients. One of the most important goals of the Global Antimicrobial Resistance and Use Surveillance System (GLASS) is timely identification and transmission of Emerging Antimicrobial Resistance (EAR) or outbreak of antibiotic resistance. One of the main ways to identify this "emerging" at the national or local level is to identify deviations from the expected resistance in drug compounds. As a result, if the observed cases of a drug-resistant pathogen are significantly higher than expected, it could indicate "emerging".Purpose: This study aimed to identify and transmit EAR or outbreak of antibiotic resistance among antibiotics used in the treatment of nosocomial infections caused by E. coli. This was done by comparing the observed cases of resistant E. coli with the predicted cases of resistant E. coli, which were predicted by the compartment model.Methods: This is a hospital-based study that used data from the nosocomial infection survelliance system to investigate observed cases of antibiotic resistance. In this study, the results of 12,954 antibiogram tests related to 57 hospitals located in 31 provinces of Iran were divided into two parts (results related to the first half of 2017 and results related to the second half of 2017). The model was developed in the second half of the year to predict expected cases. Before developeing model to predict the expected cases of resistant E. coli, the validity of the model was evaluated by implementing the model in the first half of the year. Finally, the predicted cases of resistant E. coli were compared with those observed in 2017. If the difference between the two was statistically significant, it indicated the outbreak of E.coli. This model evaluated 11 antibiotics recommended by the World Health Organization that are used to treat nosocomial infections caused by E. coli.Results: The results of this study showed that the outbreak of E. coli resistant to ampicillin and ceftazidime occurred in 2017 in hospitals of Iran. This means that resistance to ampicillin and ceftazidime antibiotics in nosocomial infections caused by E. coli is higher than expected and has become "emerging".Conclusion: This study showed how the outbreak of antibiotic resistance in the country's hospitals can be investigated. Using the method of this study, we can investigate the outbreak of antibiotic-resistant E. coli in the coming years and in different substrates. The results of this study showed that the administration and use of antibiotics should be reconsidered.

Antibacterial and antibiofilm effect of silver and gold nanoparticles in Uropathogenic Escherichia coli

Nosocomial infections of the urinary tract are the most common nosocomial infections. Infectious diseases currently pose a life threatening due to the increasing phenomenon of infectious agent resistance. One of the factors known to cause resistance to broad-spectrum antimicrobials agent is the susceptibility to biofilm formation. The use of silver nanoparticles (NPs) is now regarded as one of the most promising strategies to target infections associated with biofilms. This study aims to determine the application of nanotechnology in the form of metal nanoparticles in targeting the formation of biofilms on infectious agents. The antibacterial and antibiofilm activity test was performed on a 96-well microtiter plate on uropathogenic Escherichia coli (UPEC) at concentrations of 0, 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100 ppm. The results showed the addition of silver and gold nanoparticles at different concentrations affected and inhibited the growth of UPEC and prevented the formation of biofilms, as indicated by a decrease in the OD value. In conclusion, silver and gold nanoparticles have antibacterial and antibiofilm effects on UPEC.

Prevalence of nosocomial infections in Covid-19 patients admitted to the intensive care unit of Imam Khomeini complex hospital in Tehran

Background and Objectives: Nosocomial infections (NIs) are an important cause of mortality and morbidity in intensive care units (ICU). Pneumonia is the most common serious manifestation of infection in Covid-19 patients. The aim of this study was to investigate the prevalence of pneumonia in Covid-19 patients admitted to the ICU. Materials and Methods: In this cross-sectional study, 1240 Covid-19 patients admitted for more than 48 h in the ICUs of Imam Khomeini Complex Hospital (IKCH) in Tehran for seven months in 2020 were included in the study with initial di- agnosis of Covid-19 (PCR test and chest imaging). Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, length of ICU and hospital stay, microbial type and antibiotic resistance. In this study, the pattern of antibiotic resistance was determined using the disk difusion method. Results: In this study, 289 (23.3%) out of 1320 patients experienced NIs. 221 (76.4%) out of 289 patients had underlying diseases and the most common of which were hypertension, diabetes and heart disease, respectively. 163 patients (56.4%) were RT-PCR COVID-19 positive and 200 patients (69%) died. The majority of patients with NIs (71%) were over 55 years old. The most common type of nosocomial infection (66%) was ventilator-associated pneumonia (VAE). The most common microorganisms that cause pneumonia were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aerugino- sa, respectively. Conclusion: Pneumonia infection is high in Covid-19 patients admitted to the ICU, it needs to be planned with the diagnosis and measures related to the control and prevention of this infection.

Significance of gram-resistant flora in etiology of nosocomial infections in determining rational antibiotic therapy

In recent years, the problem of resistance of gram-negative microorganisms to carbapenems, as well as the emergence of multiresistant strains is gaining urgency. This problem is of particular importance in neonatal practice due to the age limitations of the use of many antibiotics and the lack of specific recommendations. Local bacteriological monitoring data should be taken into account when selecting a starting antibiotic, and for this purpose, methods of rapid identification of the pathogen and its resistance mechanisms should be introduced. Pediatricians need controlled trials of new antibiotics to successfully treat MDR-Gram-infections.